Consequences of reocclusion after successful reperfusion therapy in acute myocardial infarction. TAMI Study Group.

Abstract

fractions compared with patients with sustained patency at follow-up. However, patients with reocclusion at follow-up had worse infarct-zone function at -2.7 (value, -3.2/-1.8) versus -2.4 (SD/chord) (value, -3.11-1.3) (p=0.016). The recovery of both global and infarct-zone function was impaired by reocclusion of the infarct-related artery compared with maintained patency; median A ejection fraction was -2 compared with 1 (p=0.006) and median A infarct-zone wall motion was -0.10 compared with 0.34 SD/chord (p=0.011), respectively. In addition, patients with reocclusion had more complicated hospital courses and higher in-hospital mortality rates (11.0%7 versus 4.5%, respectively; p=0.01). We conclude that reocclusion of the infarct-related artery after successful reperfusion is associated with substantial morbidity and mortality rates. Reocclusion is also detrimental to the functional recovery of both global and infarct-zone regional left ventricular function. Thus, new strategies in the postinfarction period need to be developed to prevent reocclusion of the infarct-related artery. (Circulation 1990;82:781-791) r..3. nhe use of thrombolytic therapy in patients with

The smoker’s paradox after successful fibrinolysis: reduced risk of reocclusion but no improved long-term cardiac outcome

“…The reduced risk was observed consistently across many different subgroups and occurred independent of antithrombotic regimen and culprit stenosis severity, a known strong predictor of reocclusion in this setting [27][28][29]. The majority of reocclusions have been shown to occur without clinical reinfarction [12][13][14]. In our study reocclusion occurred without clinical reinfarction in almost 80% of cases, while 46% of patients with reocclusion did not experience recurrent ischemic events.…”

“…Given the strong relationship between reocclusion and outcome after successful fibrinolysis [12][13][14], previous studies addressed the risk of reocclusion in smokers in search for potential mechanisms explaining their favorable outcome. Results of these studies have been conflicting.…”

“…After successful fibrinolysis, outcome is strongly related to reocclusion of the infarct artery, which portends an increased risk of death, reinfarction and revascularization [12][13][14]. Notably, most reocclusions occur without clinical reinfarction [12][13][14].…”

“…Notably, most reocclusions occur without clinical reinfarction [12][13][14]. Even in these cases, reocclusion has adverse impact on recovery of left ventricular function [15].…”

Left ventricular function at 3 months after successful thrombolysis. Impact of reocclusion without reinfarction on ejection fraction, regional function, and remodeling.

“…In the range of ejection fractions <50%, an end-systolic volume of > 100 mL, measured at 1 to 2 months after infarction, is an even stronger predictor of mortality.2 Treatment of myocardial infarction should thus be aimed at limitation of infarct size and preservation of end-systolic volume. Thrombolysis has been shown to improve survival after myocardial infarction3 and also improves left ventricular volume.4 Successful thrombolysis, however, is associated with a risk for reocclusion that averages 10% to 20% before hospital discharge5,6 and was recently reported to occur in almost 30% after 3 months.7 '8 Reocclusion occurs without symptoms in about half of the patients5 but is nevertheless associated with higher mortality rates, impaired recovery of left ventricular function, and a more complicated hospital course. 5 To date, no studies have been reported in which the impact of reocclusion observed after 3 months has been related to changes in global and regional ventricular function and to changes of left ventricular volumes during that period in a group of patients that did not sustain recurrent infarction after thrombolysis. For the study of ventricular function, a time window of 3 months is of interest because by then vital myocardium in patients with sustained reperfusion is likely to have completely recovered from stunning.…”